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A Conspiracy Of Silence - Part I: Training

Written by Allan Besselink, PT, Dip.MDT

Sunday, 30 November 2008

"The inability to challenge our belief systems in the face of good scientific evidence is the primary limiting factor in the advancement of both health care and coaching, as well as human performance and injury prevention" (excerpt taken from "RunSmart" - 2008)

There
is a conspiracy of silence in our community. It is evident in our
health care, and it is evident in the world of fitness and coaching.
It is a powerful undercurrent, a stealthy viral element that attacks
us from all sides. Not a day goes by in which I don't witness it's
effects. And the first step required to get down to the real issues
in health care and fitness on a much broader scale, is to acknowledge
and address it.

Much
of what we experience in the context of health care and fitness is
what I would term "Flat Earth Syndrome". Let me explain.
For a great part of world history, civilization thought that the
world was flat. It was part of the commonly-held belief system of the
ages. It was actually part of the religious beliefs as well.

And
then we discovered that - it wasn't. If you sailed a ship, you didn't
fall off the edge of the world. You actually just kept on sailing.
And suddenly, there was science to prove that the world was, indeed,
spherical.

“Shhhhh,
don't talk about this. We have empirical evidence – and that's all
we have ever needed. We need to be careful with this science stuff,
because if it takes hold, we might lose our power and control. So
let's just be quiet about it. Maybe if we don't talk about it, it
will go away."

But lo and behold,
many people weren't ready for the science. It remained a religious
issue. It was near-heresy to proclaim that the world was round.
People were persecuted for their newfound beliefs. And try as science
might, it was a supreme challenge to get people to move past their
beliefs into the realm of "scientific evidence". But,
eventually, we got there - and now look where we are. We travel to
other planets, and all while watching our spherical globe circle
below us.

When our belief
systems are challenged - be it with religion, politics, health care,
fitness, or quantum physics, we are faced with an opportunity. It is
an uncomfortable one, but an opportunity nonetheless. We can go
onward into the abyss simply ignoring the evidence and refusing to
acknowledge that it is our beliefs that make us uncomfortable. We can
become defensive to those around us who espouse different beliefs. Or
we can simply open ourselves to reflection, self-assessment, and
learning. We can look beyond the emotion and respond to the evidence.
That is in fact a choice.

What we see in health
care - and in the fitness world - is no different. It is yet another
example of "Flat Earth Syndrome". In the meantime, it is
also a conspiracy of silence. Maybe if we don't talk about the
issues, they will go away. But they never do. If anything, they
become more virulent.

With this in mind, let
us take a look at fitness and coaching. And for a more specific,
real-world example, let's look at the running community (in Austin
and beyond) – and examine a snapshot of what has become acceptable
in that community.

If we were to look at
any 10 books on running, we'd find that most of them continue to
promote concepts of training that do not even consider the last 20
years of sports science and physiology literature. If we were to then
look at any 10 groups training for a marathon in Austin (or any other
running community), we'd find a similar trend.

“But
this is the way such-and-such trains” and thus that must be
effective, right?

If we didn't have
access to information, then this might be understandable. But the
worst part is that much of the best sports science research in the
world is being done right in our own backyard – inside Belmont Hall
at the University of Texas – and the community in general still
refuses to utilize it.

A perfect example is
the “recovery run”. There is good research to support easy
running immediately after your workout to foster recovery. But this
is at the time of the workout – not as a means of adding miles to
your plan the next day! But if the belief is that “more miles are
better”, then the current version of the “recovery run” fits.
It's just too bad that it takes good scientific information
completely out of context.

And if we were to look
beyond simple training methodologies, then we would need to examine
how these training methods relate to both the success rate of the
athlete and the rate of incidence of running injuries. Data from
Runner's World magazine would indicate that 60% of runners will
sustain an injury in any given year that will cause them to stop
training. The sports sciences would indicate – consistently, I
might add – that there is but one thing that correlates with
running injury – and that is what is termed “training error”.
When you read a little more, you find that “training error”
equates to “too much too soon”. The rate of application of
training stimulus exceeds the rate of training adaptation – and
tissue injury occurs. There are also studies that would indicate that
the risk of injury increases significantly at as low as 25 miles per
week of training – not very high for many training programs, once
you've added in all your “recovery runs” and “long runs”.

And much of this
information has been readily available for the last two decades.

But, if there are two
aspects that are not well-controlled or methodically progressed in
most group training programs, they are the total volume of training,
and the rate at which it is progressed. Oh sure, they all profess to
use the legendary “10% rule” but this becomes an arbitrary value
having little to no relevance to the overall training program.

When the accepted
community standard is a 60% injury rate then we have a major problem
on our hands. When you factor in Governor Rick Perry's stated goal of
creating “healthy citizens” in Texas,
we now have an unacceptable public health problem. More people are
running, but more people are getting injured while running.

Ask any of the major
training groups locally – most won't be able to tell you their
injury rates or their success rates in getting runners to their event
injury-free.

And if you do get
injured, you are told that it's because of your lousy genetics or
your poor flexibility or any of a plethora of reasons unsubstantiated
in the scientific literature. No worries, you can get that problem
fixed (more on health care in article number two) and then you might
even be able to jump right back into your program, if luck and timing
would have it.

Where is the
accountability?

Numbers such as these
are abysmal if we acknowledge that the information to prevent those
injuries is readily available. But – it's “the way we do things
around here”, and those things are an accepted community standard
of behavior.

But
much as Jack Nicholson proclaimed in “A Few Good Men” … as it
stands right now, the community (as we know it) "can't handle the
truth".

“How dare I say
this”, you might be asking now. “There are a lot of successful
marathon training groups in Austin”. Perhaps you're even thinking
of a specific example of someone that has succeeded within any number
of them. Don't worry, I can hear the outrage brewing in your voice.
That's just the initial visceral response. But now for the choices.

Let's
face it - we are in a world of very accessible information. Years
ago, reference libraries like PubMed were only accessible through
large universities. Now, the scientific evidence to support or refute
just about anything is readily available. Part of my rationale for
writing "RunSmart" was to make current sports sciences
literature accessible to the masses. It contains 96 references, most
of which are peer-reviewed journals. And that is only scratching the
surface. It is a simple task for the athlete to become a consumer of
the information. Compare outcomes. What is the injury rate in any
given group training program (or any training program, for that
matter)? How many make it to the start line injury-free? How many
fall out of the program due to injury?

We continue to talk
amongst ourselves about “base training” and the like - but don't
ever provide scientific evidence to the contrary, otherwise you'll
hear something akin to …

"Stone him”

“Blasphemer”

Or worse.

No matter what
evidence you provide, the belief system is still the same. It's a
cultural belief system. You will experience it in training groups and
in discussion forums – but just don't be the one challenging the
beliefs, because there is a predictable behavioral response to this.
All we have to do is look back at history. When you challenge the
“system”, it's amazing how much the “system” pushes back. You
might hear “the believers” launch a tirade on your credibility.
It might be in public or private.

“Shhhhh,
don't talk about this. We have empirical evidence – and that's all
we have ever needed. We need to be careful with this science stuff,
because if it takes hold, we might lose our power and control. So
let's just be quiet about it. Maybe if we don't talk about it, it
will go away.”

You'd almost be
convinced the world is flat – all over again. A conspiracy of
silence.

As they say, you can
lead a runner to injury prevention and training optimization, but you
cannot make him drink from that stream of knowledge.

We have the capacity
to engage in constructive discussion, to share ideas, and to evolve
our thought processes. If the active community benefits, we all
benefit. But it requires us to face the conspiracy of silence in our
community first.

The next article will
take us into another area of deafening silence - health care.